Selling a Gastroenterology Practice in 2026: Multiples, Named Buyers, and the GI-MSO Playbook
Quick Answer
A US gastroenterology practice in 2026 typically sells for roughly 6x to 13x EBITDA. GI is one of the most active physician-services consolidations because of ASC ownership economics (endoscopy ASCs are highly profitable), aging-demographic colonoscopy demand, and ancillary services (pathology, anesthesia, infusion). By profile: single-MD GI ($500k-1.5M EBITDA) goes 5x-7x; multi-MD single-site or 2-3 location practice ($1.5-5M EBITDA) goes 6x-9x; small regional GI group with ASC ($3-10M EBITDA) goes 8x-11x; mid-size platform ($10-30M EBITDA, multi-site ASC + pathology + anesthesia) goes 10x-12x; premium scale platform ($30M+ EBITDA, multi-state, full ancillary suite, named commercial in-network) reaches 11x-13x+. Active buyers include GI Alliance (Apollo Global Management, the largest US GI MSO with ~800+ providers, ~$1.4B+ platform), US Digestive Health (Amulet Capital + Frazier Healthcare Partners), One GI (Frazier Healthcare Partners), Allied Digestive Health (PE-backed), Capital Digestive Care, Gastro Health (CVS Health subsidiary post 2024 acquisition), GastroIntestinal Specialists (Webster Equity Partners), plus PE sponsors (Apollo Global Management, Amulet Capital, Frazier Healthcare Partners, Webster Equity Partners, Audax Group). The biggest multiple drivers are ASC ownership (endoscopy ASCs are the major multiple-builder), ancillary services (in-house pathology, anesthesia, infusion), commercial payer mix, value-based-care positioning (colonoscopy bundles, IBD value-based contracts), and modern EMR. Buyer-paid M&A advisory (CT Strategic Partners) costs the seller nothing.
If you own a US gastroenterology practice in 2026, the M&A market is one of the most active and well-capitalized physician-services consolidations. GI Alliance (Apollo Global Management) is the dominant US GI MSO at ~800+ providers and ~$1.4B+ platform scale. US Digestive Health, One GI, Allied Digestive Health, and Gastro Health (now CVS Health subsidiary) compete. PE sponsors continue regional rollups driven by endoscopy ASC economics, ancillary integration, and IBD/value-based-care opportunity.
What the asset is worth depends on three things: (1) endoscopy ASC ownership with Stark-compliant structure, (2) ancillary services (in-house pathology, anesthesia, infusion for biologics), and (3) commercial payer mix plus IBD center participation. This guide covers real multiples by profile, the named buyers transacting, and the operator-level diligence buyers will run.
What this guide covers
- GI multiples 2026: 5x-7x for single-MD, 6x-9x for multi-MD, 8x-11x for small regional with ASC, 10x-12x for mid-size platforms, 11x-13x+ for premium scale with full ancillary suite.
- Active buyers: GI Alliance (Apollo Global Management, ~800+ providers, ~$1.4B+ platform, largest US GI MSO), US Digestive Health (Amulet Capital + Frazier Healthcare Partners), One GI (Frazier Healthcare Partners), Allied Digestive Health (PE), Capital Digestive Care, Gastro Health (CVS Health subsidiary 2024), GastroIntestinal Specialists (Webster Equity Partners).
- PE sponsor activity: Apollo Global Management (GI Alliance), Amulet Capital, Frazier Healthcare Partners, Webster Equity Partners, Audax Group.
- Multiple drivers: endoscopy ASC ownership (the major multiple-builder), ancillary services (in-house pathology, anesthesia, infusion for biologics), commercial payer mix, IBD center participation, value-based-care contracts, modern EMR (Modernizing Medicine EMA-Gastro, Provation, gMed).
- Things that compress: no ASC ownership, weak ancillary integration, owner-MD dependence, Medicare-heavy, Stark/anti-kickback exposure, single-state, weak pathology integration.
- Sellers pay nothing on CT Strategic Partners’ buyer-paid advisory.
Named M&A transactions (2021-2025)
| Target | Buyer | Year | What it tells us |
|---|---|---|---|
| Gastro Health acquired by CVS Health | CVS Health | 2024 | Payer-strategic acquired major GI MSO; reshapes GI competitive landscape. |
| GI Alliance continued growth | Apollo Global Management | 2022-2025 | Dominant US GI MSO continues aggressive tuck-in M&A. |
| US Digestive Health expansion | Amulet Capital + Frazier Healthcare Partners | 2022-2025 | PE-backed GI platform continues regional rollups. |
| One GI expansion | Frazier Healthcare Partners | 2022-2025 | Tennessee/Southeast GI platform continues regional growth. |
| Allied Digestive Health growth | PE-backed | 2022-2025 | NJ-anchored multi-state GI platform continues expansion. |
The named buyer landscape
PE-backed national GI MSOs
- GI Alliance (Apollo Global Management) — ~800+ providers, ~$1.4B+ platform, the largest US GI MSO.
- US Digestive Health (Amulet Capital + Frazier Healthcare Partners) — multi-state.
- One GI (Frazier Healthcare Partners) — Tennessee/Southeast.
- Allied Digestive Health (PE-backed) — New Jersey-anchored multi-state.
- Capital Digestive Care — Mid-Atlantic.
- GastroIntestinal Specialists (Webster Equity Partners).
Strategic acquirer
- Gastro Health (CVS Health subsidiary, acquired 2024) — payer-integrated GI MSO.
PE sponsors active in this space
- Apollo Global Management (GI Alliance), Amulet Capital + Frazier Healthcare Partners (US Digestive Health + One GI), Webster Equity Partners, Audax Group.
What each buyer will pay for vs. what they reject
- Will pay premium for: endoscopy ASC ownership with Stark-compliant structure, ancillary services (in-house pathology, anesthesia services, infusion for IBD biologics like Remicade/Entyvio/Stelara/Skyrizi), IBD center participation, commercial payer mix 55%+, named value-based-care contracts (colonoscopy bundles, IBD bundles), modern EMR (Modernizing Medicine EMA-Gastro, Provation, gMed, Athenahealth), multi-state platform scale.
- Will compress or reject: no ASC ownership, weak ancillary integration, owner-MD dependence, Medicare-heavy payer mix above 60%, single-state, Stark or anti-kickback exposure, pathology not integrated, weak EMR, low colonoscopy volume relative to provider count.
The operator-level KPI playbook buyers will diligence
Procedural and case mix
- Colonoscopy volume: The volume backbone (screening + diagnostic).
- EGD (upper endoscopy) volume.
- ERCP, EUS specialty volume.
- Office visit volume (IBD management, GERD, IBS, hepatitis).
- Infusion suite volume for biologics.
ASC ownership
- Endoscopy ASC ownership and Stark-compliant structure.
- ASC accreditation: AAAHC, JC, AAAASF.
- Anesthesia model: in-house, employed, or contracted (NASP, USAP, NAPA, etc.).
- Pathology integration: in-house Stark-compliant pathology lab.
Payer mix and value-based-care
- Commercial percentage: 55%+ benchmark.
- Medicare percentage: 30-45% typical.
- IBD center designations (Crohn’s & Colitis Foundation, ASGE).
- Value-based-care contracts: Colonoscopy bundles, IBD bundles.
Provider bench
- MD count and subspecialty (IBD, hepatology, advanced endoscopy).
- APP (NP/PA) scaling.
- Provider productivity (encounters + procedures per week).
- Equity-rollover expectations (PE-MSO GI deals typically 30-50%).
Dangers and traps
1. Stark and anti-kickback exposure on ASC + pathology arrangements
ASC and in-office pathology must be Stark-compliant.
2. No ASC ownership
Endoscopy ASC is the major multiple-builder.
3. Weak ancillary integration
Pathology, anesthesia, infusion integration drives multiples.
4. Medicare-heavy payer mix
Above 60% Medicare compresses.
5. Owner-MD dependence
Build the MD/APP bench.
6. Single-state operations
Multi-state platform path matters.
7. IBD center compliance
Commercial IBD value-based contracts require infrastructure (care coordinators, patient navigators).
8. Equity rollover expectations
PE-MSO GI deals typically 30-50% equity rollover.
Our POV in 2026
GI M&A is one of the most active physician-services consolidations. GI Alliance (Apollo Global Management) dominates at ~800+ providers; US Digestive Health, One GI, Allied Digestive Health, and Gastro Health (CVS Health 2024) compete. Endoscopy ASC ownership is the major multiple-builder. Value-based-care (colonoscopy bundles, IBD bundles) is the structural tailwind.
The right time to prepare is 12-18 months before going to market — structure Stark-compliant endoscopy ASC + pathology, integrate anesthesia, build IBD center capability.
Preparing your business for sale: 12-18 months out
- Get multi-year audited financials.
- Structure Stark-compliant endoscopy ASC + pathology lab.
- Integrate anesthesia services.
- Build IBD center capability with infusion.
- Develop value-based-care contract participation.
- Confirm commercial in-network status.
- Build the MD/APP provider bench.
- Modernize EMR (Modernizing Medicine EMA-Gastro, Provation, gMed).
- Run a competitive process. GI Alliance (Apollo Global Management), US Digestive Health (Amulet Capital + Frazier Healthcare Partners), One GI (Frazier), Allied Digestive Health, Capital Digestive Care, Gastro Health (CVS Health), GastroIntestinal Specialists (Webster Equity Partners), plus PE sponsors directly.
About the Author
Christoph Totter is the founder of CT Acquisitions, a buy-side partner headquartered in Sheridan, Wyoming. We work directly with 76+ buyers, search funders, family offices, lower middle-market PE, and strategic consolidators, including direct mandates with the largest home services consolidators that other intermediaries can’t access. The buyers pay us when a deal closes, not the seller. No retainer, no exclusivity, no contract until close. Connect on LinkedIn · Get in touch
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What is the typical multiple for a gastroenterology practice in 2026?
Single-MD GI practices typically sell at 5x-7x EBITDA. Multi-MD single-site or 2-3 location practices ($1.5-5M EBITDA) go 6x-9x. Small regional GI groups with endoscopy ASC ($3-10M EBITDA) go 8x-11x. Mid-size platforms ($10-30M EBITDA, multi-site ASC + pathology + anesthesia) go 10x-12x. Premium scale platforms ($30M+ EBITDA, multi-state, full ancillary suite, named commercial in-network) reach 11x-13x+.
Who are the active buyers of gastroenterology practices right now?
PE-backed national GI MSOs: GI Alliance (Apollo Global Management, ~800+ providers, ~$1.4B+ platform, largest US GI MSO), US Digestive Health (Amulet Capital + Frazier Healthcare Partners), One GI (Frazier Healthcare Partners), Allied Digestive Health (PE), Capital Digestive Care, GastroIntestinal Specialists (Webster Equity Partners). Strategic: Gastro Health (CVS Health subsidiary, acquired 2024). PE sponsors: Apollo Global Management, Amulet Capital, Frazier Healthcare Partners, Webster Equity Partners, Audax Group.
What hurts a gastroenterology practice’s valuation most?
No endoscopy ASC ownership (ASC is the major multiple-builder), Stark or anti-kickback exposure on ASC + pathology arrangements, weak ancillary integration, owner-MD dependence, Medicare-heavy payer mix, single-state operations, weak pathology integration, weak EMR, and IBD center capability gaps.
Why is endoscopy ASC ownership so important?
Endoscopy ASCs are among the most profitable ASCs because of high-volume colonoscopy + EGD economics with relatively simple recovery and fast turnover. Stark-compliant ASC ownership provides material additional EBITDA from facility fees and creates a buyer-attractive surgical platform. GI MSO platforms with ASC ownership achieve 3-4 turns of EBITDA multiple premium over no-ASC practices.
What is the typical equity rollover in a GI MSO transaction?
PE-MSO GI deals typically include 30-50% equity rollover for selling MDs. The rollover equity participates in the next platform exit. Understanding rollover valuation and second-sale terms is critical before signing LOI.
Do I have to pay a broker fee?
No. CT Strategic Partners runs a buyer-paid M&A advisory model. The seller pays nothing.
How long does it take to sell a GI practice?
Typical process 5-9 months. Add 12-18 months of preparation.
When should I start preparing if I plan to sell in 2027 or 2028?
12-18 months before going to market. Highest-leverage work: structure Stark-compliant endoscopy ASC + pathology, integrate anesthesia, build IBD center capability, develop value-based-care positioning.
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