Seven steps for PE-backed ophthalmology CFOs to see profits

You don’t need 20-20 vision to see the avalanche of eye care-related deals across the PE space. IMARC Group valued the market at $74B in 2024, with expectations to reach $94B by 2033. Within the broader eye care market, ophthalmology continues to attract funding from a wide variety of investors, totaling around $6.8B+ in 2024, according to Market Scope. And the deal landscape is entering a new chapter: in January 2025, Cencora paid $4.4B for an 85% stake in Retina Consultants of America, while McKesson signed to acquire an 80% stake in Prism Vision Holdings for approximately $850M, signaling that publicly traded strategics are now absorbing what PE built. Across the Atlantic, MidEuropa recently exited its European ophthalmology platform Optegra to EssilorLuxottica, and as recently as this week, Goldman Sachs, Gryphon Investors, and Olympus are among the PE firms still actively pursuing new platform investments and consolidation plays in eye care.

But there’s a blind spot: deal volume has fallen sharply. Fewer than 100 groups transacted in 2025 compared to more than 300 at the 2021 peak, and VMG Health expects lower volumes to continue into 2026 as investors grow more selective, favoring fewer but higher-quality deals. By and large, investors paid a premium on these ophthalmology roll-ups, and neither the doctors who sold their practices nor the LPs who invested in them have seen the expected ROI

ROI. The problem is that most of these roll-ups have done “just enough” integration to leverage some synergies, but not enough to pave a path toward real profitability, at least, not in a bifurcated market where premium valuations go to the few platforms that got integration right, while the rest face compressed exits.

Reading the bottom line: Almost all PE-backed ophthalmology practices can benefit from addressing “delayed integrations” now in order to recover hidden value left on the roll-up floor.

Why PE is eyeing the ophthalmology space:

There’s no shortage of reasons why PE has been focused on the sector. From a macro perspective, there’s the increasing prevalence of eye-related disorders (especially with an aging population), heightened awareness about eye health, and technological advancements that make diagnosis, treatment, and surgeries more effective than ever. There is, however, a meaningful new headwind: the 2026 Medicare Physician Fee Schedule introduced an 11% cut to surgeon reimbursement for cataract surgery (CPT 66984), (the largest single-year reduction in three decades), compressing margins for platforms built on high surgical volume. From an operational perspective, as with other single specialty practices, there’s room to implement efficiency improvements, build more scalable infrastructure, and enhance technology.

But PE-backed ophthalmology companies haven’t yet exploited all available value creation levers. Most have consolidated enough to leverage economies of scale in purchasing, but in their quest to grow bigger faster, they have not yet fully centralized operations and/or streamlined the back office at scale. And at the end of the day, it is these processes and efficiency gains that drive value.

How CFOs can see their way to success:

The good news is that there are seven specific steps that almost all PE-backed ophthalmology CFOs can take to realize a path toward enhanced profitability:

1. Optimizing drug procurement

On balance, CFOs have done well here: by centralizing procurement, they’ve been able to negotiate volume discounts with suppliers and get better visibility and control over drug purchases. But there’s more to be done, starting with streamlining the procure-to-pay (P2P) process. Too many roll-ups are burdened by unnecessary purchasing steps, (manual approvals, redundant paperwork, or inefficient workflows that slow operations and drive up costs), and streamlining the P2P process helps fix that. The key here will be to train their doctors to use these new processes to effectively use a centralized P2P system. Without that training, they’ll continue to order inefficiently or bypass the system altogether, ultimately undermining its impact on cost savings.

CFOs should also be modeling a meaningful tailwind: thanks to the Inflation Reduction Act and recently negotiated most-favored-nation drug pricing, certain Medicare Part B drugs (including high-cost anti-VEGF agents central to retina practices) are expected to see significant price reductions in 2026, in some cases approaching 70%

2. Streamlining IT infrastructure

Most healthcare roll-ups operate with a tangled web of EMR systems, driving up maintenance costs and making patient data retrieval slow and inefficient.

A centralized data lake might seem like a fix, but it’s not enough; if your EMRs remain fragmented, integrating patient data into your ERP will still be a challenge. To truly streamline operations, you need to consolidate and standardize your EMR data, minimizing the number of platforms in use. This ensures consistent, reliable, and structured patient data across the organization that seamlessly integrates with your ERP, boosting efficiency, and, ultimately, improving quality of care.

After you’ve achieved scale, it’s worth turning your IT attention to the front office, as manual tasks like intakes/scheduling, billing, and claims processing quickly become bottlenecks, making automation essential to keep operations running smoothly. What’s more, as your IT systems become more connected (as they should), cybersecurity needs to be a top priority. Sensitive patient data is a prime target for cyber threats, and while strong security might require a significant upfront investment, failing to protect your data will be far more costly down the road.

3. Enhancing revenue cycle management

Any healthcare provider knows that revenue cycle management (RCM) is critical to driving both cost reduction and revenue growth. Clean claims start with accurate patient intake at the front office, and demand well-defined and standardized processes throughout the entire cycle, ensuring every dollar earned is efficiently collected and maximized to drive up the bottom line.

To cut RCM costs, you should automate core business functions, leverage labor arbitrage, and implement a strong underpayment recovery strategy that ensures insurers and payers are reimbursed the full amount owed, a holistic strategy that reduces manual errors, shifts routine tasks to lower-cost teams/automation, and maximizes efficiency for cost savings. This is particularly urgent in 2026: the expansion of Medicare’s prior authorization demonstration program now covers a broader range of ophthalmic procedures across 10 states, meaning clean documentation and PA compliance are no longer optional; they’re a direct revenue protection tool.

To drive revenue, or prevent revenue leakage, you can both reduce initial denials, (by ensuring clean claims from the start and minimizing rework), and decrease final denial write-offs by tightening follow-up processes with insurers. You should also use analytics capabilities to identify patterns in denied claims and adjust your strategy accordingly.

4. Improving the organizational structure

With the right organizational structure, you can generate cash flow from inside the house. This means capturing referral-related revenue from any additional surgeries and drug/eye care partnerships; instead of referring patients to physicians outside the practice networks (which is typical for most single specialty providers), it’s important that providers know their in-network referral options for compounded revenue. One important caveat for 2026: referral consolidation strategies are drawing increased regulatory scrutiny, as state-level corporate practice of medicine laws and anti-kickback frameworks continue to evolve. CFOs pursuing aggressive in-network referral capture should ensure legal review is part of the implementation plan.

Improving the organizational structure also includes optimizing your physician/clinical staffs’ workload, which, if you’ve followed steps 1-3, you’ve done. Reducing the administrative burden with automated and optimized processes lets staff focus less of their energy on the front office and more on their patients.

5. Addressing treasury nuances

The treasury function is particularly important in a physician setting; with cash flow relying on often unpredictable insurance reimbursements, ophthalmology roll-ups need to have all eyes on their finances. This means:

1. Strengthening financial stability by optimizing the cash flow forecast, debt/liquidity management, and working capital: Because insurance reimbursements are so often delayed, it’s critical to have a precise cash flow forecast that gives you an accurate projection of liquidity (taking debt obligations into consideration) and an optimized working capital structure for managing receivables, payables, and inventory.
2. Consolidating banking and cash management: Many roll-ups inherit multiple banking relationships from acquired practices, and it’s much more efficient (and much cheaper) to consolidate them.
3. Optimizing credit card “merchant services”: Many patients pay via credit card. Optimizing merchant services ensures smoother transactions and lower costs.
4. Offering financing plans to patients: Making payment plans/third-party medical financing available can increase affordability and revenue collection, reducing outstanding receivables (and increasing patient satisfaction).

6. Optimizing capital spend

Historically, when doctors want new equipment, they go out and buy it—few questions asked. But to ensure your organization is tracking toward its financial goals, overarching capital spending controls are crucial for balancing necessary medical investments with financial sustainability.

7. Keeping on top of KPIs

You know it already: staying on top of your KPIs is crucial for business visibility. But aligning on the right KPIs, (those that directly support your strategy), is equally as critical. This means, for example, standardizing inventory levels of the amount of frames, lenses, and medical supplies, while ensuring optimal staffing to maintain high-quality operations. Beyond that, to get a true measure of profitability in a business where drugs are a major cost factor, you need to track gross profit divided by sales minus material costs, a metric that provides a clearer picture of performance and empowers you to adjust your business strategy in a way that maximizes value creation.

The path to successful ophthalmology exit is through delayed integration value creation, and PE-backed eye care CFOs need to lead that charge. By following the seven steps outlined above, they can eke out every bit of value from their roll-up and position their organization for high returns at exit, finally seeing the promised ROI (no glasses needed).