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Oct 10, 2024

EBITDA: The Return. Value Adjusted EBITDA and Add-Backs 

Can’t Get Enough of EBITDA? Meet Value Adjusted EBITDA and Add-Backs!

In our previous article, “EBITDA—A Guide for the Uninitiated”, we explored the fundamentals of Earnings Before Interest, Taxes, Depreciation, and Amortisation (EBITDA) and its crucial role in mergers and acquisitions. 

We explored how this financial metric provides valuable insights into a company’s operational performance, cash flow, and overall value.

However, in M&As—particularly when it comes to dental and healthcare practices—there’s another layer to consider: Adjusted EBITDA. 

This refined metric and its companion concept of ‘addbacks’ play a pivotal role in providing a more accurate picture of a business’s true financial health and potential.

Whether you’re a practice owner considering an exit strategy or a potential buyer looking to make an informed investment, grasping the nuances of Adjusted EBITDA and add-backs can significantly impact your decision-making process.

In this article, we’ll build upon our previous EBITDA discussion to explore:

So, let’s roll up our sleeves and dive in!

What Exactly is Adjusted EBITDA?

While EBITDA provides a useful snapshot of a company’s operational performance, 

Adjusted EBITDA takes this concept further, offering a more nuanced and often more accurate picture of a business’s true earning potential.

Put simply, adjusted EBITDA is a refined version of standard EBITDA that considers non-recurring, irregular, or discretionary expenses. 

It’s an attempt to normalise a company’s earnings by eliminating factors that may not reflect the ongoing operational reality of the business.

Why Use Adjusted EBITDA?

The primary purpose of Adjusted EBITDA is to provide potential buyers with a clearer view of what the company’s earnings might look like post-acquisition.

 It aims to present a more accurate representation of the sustainable, recurring cash flows a new owner could expect to generate from the business.

How it Differs from Standard EBITDA

While standard EBITDA focuses on removing the effects of financing decisions, tax environments, and accounting practices, Adjusted EBITDA takes into account additional factors that might be unique to the current ownership or represent one-off events.

For example, standard EBITDA might include the owner’s salary, which could be higher than the market rate. 

Adjusted EBITDA would add back the portion of the salary that exceeds the market rate, providing a more accurate picture of the business’s profitability under new ownership.

Why Adjusted EBITDA Matters in M&A Valuations

In the context of mergers and acquisitions, particularly in the dental and healthcare sectors, Adjusted EBITDA has become the go-to metric for several reasons:

Comparability

Adjusted EBITDA allows for easier comparison between different practices, even if they have varying ownership structures or have experienced unique events.

Future Potential

Adjusted EBITDA better indicates the business’s future earning potential under new ownership.

Valuation Basis

Many M&A deals are priced as a multiple of Adjusted EBITDA, making it a crucial factor in determining the final sale price.

Synergy Identification

For strategic buyers, Adjusted EBITDA can help identify potential synergies and areas for improvement post-acquisition.

Crucial Concept

Understanding Adjusted EBITDA is crucial for buyers and sellers in the M&A process. 

For sellers, it’s an opportunity to present the business in the best light by highlighting its true earnings potential. 

Meanwhile, for buyers, it provides a more accurate basis for valuation and helps identify potential areas for value creation post-acquisition.

However, it’s important to note that while Adjusted EBITDA can provide valuable insights, it should always be considered alongside other financial metrics and subjected to thorough due diligence. 

In the next section, we’ll look at the concept of ‘addbacks’, which form the basis of these EBITDA adjustments.

Understanding Add-Backs

At the heart of Adjusted EBITDA lies the concept of ‘addbacks’. These are the adjustments made to standard EBITDA to arrive at a more accurate representation of a business’s earning potential. 

What is an Add-Back?

Add-backs are expenses or losses added to a company’s EBITDA to normalise earnings. These are typically costs considered non-recurring, discretionary, or not necessary for the ongoing operation of the business under new ownership.

The term ‘add-back’ comes from the process of literally adding these expenses back to the EBITDA figure, thereby increasing the earnings number. 

However, it’s worth noting that some adjustments can be negative, effectively reducing EBITDA.

Add-Backs and M&As

The primary purpose of addbacks in M&A is to provide a clearer picture of what the business might look like under new ownership. They aim to:

Normalised Earnings

By removing unusual or one-time expenses, addbacks help create a more stable and predictable earnings figure.

Reflect Future Performance

Addbacks can help project the business’s performance going forward, assuming certain expenses won’t continue under new ownership.

Highlight True Profitability

By adding back discretionary expenses, the true profit potential of the business can be more accurately represented.

Facilitate Comparisons

Add-backs can make it easier to compare different businesses like-for-like, even if they have different ownership structures or have experienced unique events.

How Addbacks Affect Valuation

Addbacks can have a significant impact on the valuation of a business in an M&A transaction:

Direct Impact on EBITDA

Each pound added back directly increases the EBITDA figure.

Multiplier Effect

Since many dental and healthcare practices are valued based on a multiple of EBITDA, every pound added back could translate to several pounds in the final valuation. 

For example, if a practice is valued at 5x EBITDA, a £10,000 add-back could increase the valuation by £50,000.

Negotiation Tool

Addbacks often become a crucial point of negotiation between buyers and sellers. Sellers naturally want to maximise addbacks to increase valuation, while buyers scrutinise each addback carefully.

Risk Assessment

The nature and extent of add-backs can influence a buyer’s perception of risk. A business with numerous or significant add-backs may be perceived as riskier or less stable.

It’s crucial to note that while addbacks can significantly boost a practice’s valuation, they must be justifiable and stand up to due diligence. Overreaching with add-backs can erode trust and potentially derail negotiations!

Common Types of Add-backs

In dental and healthcare practice M&A transactions, some categories of addbacks appear frequently. Understanding these can help buyers and sellers navigate the valuation process more effectively. Let’s explore the most common types of Add-backs:

  1. Non-Recurring Items

These are expenses that are not expected to continue under new ownership or are considered one-off events:

Legal Settlements and Costs

One-time Consulting Services

  1. Owner-Related Adjustments

These add-backs relate to expenses that are specific to the current owner and likely won’t continue under new ownership:

Above-Market Owner Compensation

Owner Perks

  1. Other Common Addbacks

Charitable Donations

Start-Up Costs for New Services

Excess Rent on Owner-Occupied Property

Negative Add-backs

It’s important to note that not all adjustments increase EBITDA. Some scenarios require negative add-backs:

Below-Market Owner Compensation

Deferred Maintenance

The Importance of Scrutiny in Add-Backs

Careful scrutiny of add-backs is crucial in M&A transactions. Each add-back should be verified, substantiated, and logically justified. 

Key considerations include:

Questionable addbacks include recurring ‘one-off’ expenses, overstated owner contributions, or aspirational cost-cutting. Due diligence, involving financial review, operational assessment, and market comparison, is vital in validating addbacks.

Proper scrutiny ensures a more accurate valuation, leading to fairer deals and a clearer understanding of a practice’s true earning potential.

The Impact of Addbacks on Deal Valuation

Addbacks can significantly influence the valuation of a dental or healthcare practice in M&A transactions:

Direct EBITDA Impact

Each pound added back directly increases the EBITDA figure.

Multiplier Effect

With practices often valued at multiples of EBITDA, even small addbacks can substantially increase the final valuation. For instance, a £10,000 add-back could increase the practice value by £50,000-£100,000, depending on the multiple.

Negotiation Leverage

Addbacks often become key negotiation points. Sellers aim to maximise justifiable add-backs, while buyers scrutinise each one carefully.

Risk Assessment 

The nature and extent of addbacks can influence a buyer’s perception of the practice’s stability and risk profile.

Future Performance Indicator

Well-justified addbacks can highlight potential areas for improved profitability under new ownership.

Comparative Analysis

Addbacks allow more accurate comparisons between practices with different ownership structures or recent one-off events.

In Conclusion

Understanding Adjusted EBITDA and addbacks is crucial. These concepts provide a more accurate picture of a practice’s true financial health and potential, benefiting both buyers and sellers:

Talk to the Experts

Navigating these complex financial concepts can be challenging, but it’s essential for achieving fair and successful M&A transactions.

At Pluto Partners, we specialise in dental and healthcare M&A, with deep expertise in financial analysis, including Adjusted EBITDA and addbacks. Our team can help you:

Contact Pluto Partners today for a confidential consultation on maximising value and achieving your practice transition goals.

Christina Diamanti
Abbey Road Dental Owner

A huge thank you to Max for all his help! I would not have been able to buy my practice without his professionalism, expertise and enthusiasm. He was always there to give support and advice and checked in with everyone involved at all times to make sure everything was running smoothly!

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