Turnaround of Healthcare Practice Makes Refinancing Work


Annual Sales


in Debt

Tulsa Cancer Institute, Tulsa Oklahoma


  • 50% market share in Tulsa but declining due to increased hospital based competition
  • New $45 million state of the art facility with extensive radiology equipment
  • Three years of losses with current annual EBITDA of a $4 million loss
  • $95 million of debt including $35 million building, $45 million trade creditor who served essentially as working capital lender and $15 million of equipment leases
  • Dysfunctional business management and uniformed and uninvolved physician ownership group


  • Assumed interim CEO role to lead physicians and employees
  • Improved profitability by reducing physician census and salaries
  • Negotiated key reimbursement contract price improvements
  • Started marketing and physician referral source outreach to stabilize and start to grow patient flow
  • Replaced key managers by a combination of new hires and internal promotions
  • Consolidated facilities and eliminated $2 million of annual costs
  • Developed open communications and engaged employee culture that involved physician owners in all key decisions of the turnaround process
  • Restructured trade supply debt with a 33% reduction in debt and a 4 1/2 year repayment plan at zero interest rate
  • Structured sale lease back of primary facility to deleverage business and to create significant cash reserves to guard against unexpected events
  • Assisted in recruitment of new permanent CEO


  • Annual EBITDA has increases from $4 million loss to $8 million positive
  • Debt has been reduced from $90 million to $40 million
  • $4 million of cash in the bank
  • Business is growing after years of decline
  • New CEO has taken over an exciting business opportunity