Hendon Partners
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The Quality of Earnings Report: What It Is and Why It Determines Your Final Home Care Sale Price

Neli Gertner
#QoE#due-diligence#valuation#EBITDA#home-care

You’ve signed the Letter of Intent. The buyer has agreed to a $9M enterprise value based on your $1.8M EBITDA at a 5× multiple. You feel good. Then — 45 days into due diligence — the buyer comes back with a revised offer of $7.5M.

What happened?

In most cases, the answer is the Quality of Earnings (QoE) report — a detailed financial analysis conducted by the buyer’s accounting firm during due diligence. If the QoE produces a lower EBITDA than the one in your CIM, the buyer will reprice. And sellers who don’t understand how QoE works are consistently blindsided by it.

This guide explains exactly what a QoE report is, how it works in home care transactions, what analysts look for, and — most importantly — how to prepare for it so the findings support rather than undermine your price.


What Is a Quality of Earnings Report?

A Quality of Earnings analysis is a forensic review of a company’s financial performance conducted by an independent accounting firm engaged by the buyer. Unlike a standard audit — which verifies that financial statements comply with GAAP — a QoE is specifically designed to answer the question: “Is the EBITDA in this CIM real, repeatable, and sustainable?”

The output is a report that includes:

  • A restated EBITDA figure (often different from what was represented in the CIM)
  • A breakdown of every add-back and whether the QoE analysts agree with it
  • Analysis of revenue quality (is it recurring? concentrated? at risk?)
  • Working capital analysis and normalized working capital recommendation
  • Balance sheet observations
  • Key risk observations

QoE reports cost buyers $25,000–$75,000 for a typical home care transaction. Buyers do not pay that amount to affirm the CIM — they pay it to find every dollar of EBITDA that doesn’t hold up under scrutiny.


How QoE Affects Your Purchase Price

The relationship is straightforward: if the QoE produces a lower EBITDA than the CIM, the buyer adjusts the price downward at the same multiple.

Example:

  • CIM EBITDA: $1.8M
  • LOI price: $9M at 5× multiple
  • QoE restated EBITDA: $1.5M
  • Revised buyer offer: $7.5M

A $300K EBITDA reduction at 5× = $1.5M purchase price reduction. This is not unusual in poorly prepared processes. It is extremely common in transactions where the seller’s CIM was prepared by a non-specialized advisor or by the seller directly.


What QoE Analysts Look for in Home Care

Home care has several sector-specific areas that QoE analysts scrutinize heavily:

Add-Back Validity

Your CIM EBITDA reflects “normalized” earnings — raw EBITDA plus add-backs for owner-benefit items and one-time expenses. QoE analysts challenge every add-back:

  • Owner compensation add-back: Are you really paying yourself above market? They will benchmark your role against comparable market comp data. If you claim a $250K owner add-back but the market rate for your function is $180K, only $70K holds.
  • Personal expenses: Every expense categorized as a personal charge through the business must have documentation. If you expensed a vacation as a “conference,” that is not a legitimate add-back.
  • “One-time” items: Analysts are skeptical of one-time expense claims. If you had a “one-time” legal expense last year and another one the year before, they will argue these are recurring.
  • Consulting fees to related parties: Payment to a family member or related entity will be scrutinized for market-rate validity.

Revenue Sustainability and Concentration

QoE analysts examine whether your revenue is truly repeatable:

  • Client concentration: If 30% of your revenue comes from three clients, they will assess what happens if those clients leave.
  • Episodic vs. recurring: For home health, they review whether census is building or declining, and whether any large Medicare episodes are truly repeatable.
  • Rate risk: For Medicaid-heavy agencies, they will assess recent rate changes and exposure to state budget cuts.
  • Contract expiration: Any payer contract or facility agreement expiring within 12 months is flagged as a revenue risk.

Revenue Cycle and Billing Quality

Home care has complex revenue cycles. QoE analysts will review:

  • Days Sales Outstanding (DSO): How long does it take to collect from payers? High DSO signals billing problems.
  • Denial rates: What percentage of your claims are initially denied? High denial rates indicate coding or documentation issues and suggest revenue at risk.
  • Unbilled revenue: A large unbilled balance can signal either a backlog problem or, worse, revenue that will never be collected.
  • Accounts receivable aging: Any receivables over 180 days from Medicare or Medicaid are essentially uncollectible and will be written down.
  • Cost report liability: For Medicare-certified agencies, open cost reports represent potential liabilities that reduce working capital or generate indemnification claims.

Caregiver and Employee Costs

Labor is home care’s largest expense — typically 60–75% of revenue. QoE analysts look at:

  • Hours billed vs. hours paid: Billing leakage (hours paid but not billed) reduces EBITDA and signals operational problems.
  • Overtime percentage: High overtime is both a current cost and a future risk.
  • Turnover-related costs: Recruiting, onboarding, and training costs for high-turnover businesses are normalized into EBITDA.
  • Workers’ compensation and general liability claims: Outstanding claims or a poor loss history will be reflected in reserve adjustments.

Working Capital Normalization

The QoE will produce a recommended working capital target — often the most consequential number in the report. If their recommended peg is higher than what was implicitly understood at LOI, the effective purchase price decreases dollar-for-dollar.

The QoE working capital analysis includes:

  • Average monthly working capital over the trailing 12 months
  • Adjustments for seasonality
  • Exclusion of cash (typically)
  • Treatment of AR reserves and payroll accruals

How to Prepare for a QoE Review

The best protection against a QoE that damages your price is preparation — not manipulation, but honest, proactive review of your own financials before the buyer’s accountants arrive.

1. Commission a sell-side QoE or financial review. Many experienced M&A advisors will recommend — and some will facilitate — a preliminary financial review before launch so you see what the buyer’s accountants will see. This allows you to resolve issues before they become surprises.

2. Document every add-back. Every EBITDA add-back in your CIM should be supported by documentation: bank statements, invoices, payroll records, or written explanation. An add-back without documentation will be rejected.

3. Clean up your AR before going to market. Write off clearly uncollectible old receivables. Address high-denial payers. Close open cost reports where possible. Buyers pay for clean AR — not for the chance that you might collect it someday.

4. Normalize the business before going to market. If you have been running excessive personal expenses through the business, cleaning them up a year before going to market will produce a cleaner income statement that’s less likely to generate add-back disputes.

5. Understand your revenue concentration risks and address them. Diversify referral sources before going to market. A business with evident concentration will face QoE discounts — and post-close earnout conditions designed to protect the buyer from that concentration risk.


Should Sellers Ever Commission Their Own QoE?

Yes — increasingly, sophisticated home care sellers commission a sell-side Quality of Earnings analysis conducted by their own accounting firm before launching a process.

Benefits:

  • You see what buyers will see before they see it
  • You can resolve or explain issues proactively
  • You gain credibility with buyers — a sell-side QoE signals transparency
  • You reduce the risk of price reductions in late-stage due diligence

Cost: $15,000–$40,000, depending on the scope and complexity of the business.

Return: For a transaction in the $8–15M range, a sell-side QoE that prevents even a $300K EBITDA haircut at 5× multiple saves $1.5M in purchase price. The ROI is compelling.


Final Thought: The QoE Is Not the Enemy

Sellers who understand QoE see it as a tool, not an adversarial process. Buyers need to trust that the EBITDA they’re paying for is real. A QoE that confirms (or comes close to confirming) your CIM EBITDA builds that trust, accelerates closing, and reduces the chances of price re-trades in late due diligence.

The sellers who get hurt are those who don’t understand QoE, or who presented inflated EBITDA in their CIM without supporting documentation.

Work with an advisor who helps you build a defensible EBITDA narrative — and then defend it.

Talk to Hendon Partners about preparing your financials for a competitive sale →


Hendon Partners advises home care agency owners exclusively. We do not represent buyers.

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