Expansion Playbook

The complete model for scaling Oakstone Hospice from 1 office to 10 markets.

Overview
Office Playbook
Home Office Team
Target Markets
Growth Simulator
Capital Needs
Census Build
The Expansion at a Glance
The complete model for how we scale, where we're going, and what it takes to get there.
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Office Playbook
$839K
Cost to breakeven per office. Industry avg is $1.1M. Each office follows a repeatable 18-month build arc from entity formation to profitability.
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Home Office Team
6 Key Hires
The centralized team that makes every subsequent branch cheaper and faster to launch. One of seven roles already filled.
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Target Markets
28 Markets
Verified against CMS data, Census ACS, and FY2026 Hospice Wage Index. Selected through data analysis and prior relationships.
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Growth Simulator
10 Offices
Interactive month-by-month model showing how 10 offices ramp from zero to 228 total ADC over 24 months.
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Capital Needs
$8.5M
Conservative capital recommendation for the full 10-office portfolio. Peak cumulative burn of $7.4M with buffer for the unexpected.
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Census Build
1.4 / mo
Net new patients per month from first admission. 18 months from first patient to 25 ADC per office. Idaho Falls proved 2.1.
De novo build timeline.
Each new office follows this arc from entity formation through consistent profitability. Cost to breakeven: $839K per office (industry avg: $1.1M).
Months to first patient
6
After build process starts
Months to Medicare cash
13
From inception
Cost to breakeven
$839K
Industry avg: $1.1M
Phase 1: Entity & federal setup
Stand up the legal entity and secure all federal identifiers. Nothing else moves until this is complete.
Entity formation & EIN · State tax ID · Business bank account · Insurance (GL, PL, D&O, cyber, workers comp) · Management Services Agreement · NPI (Type 2) · PECOS enrollment · CMS-855A prep
Timeline: 2-4 weeksNPI: 10-15 business days
Phase 2: Operational buildout
Runs parallel once entity is formed. State license requires an office, administrator, and medical director already in place.
Office lease & build-out · IT, phones, 24/7 on-call routing · Administrator & Medical Director hired · DON/clinical supervisor · Credentialing & background checks
Phase 3: State licensing & accreditation prep
Months 1-3 from inception. State hospice licensing, ACHC accreditation application, consulting for policies and procedures. Administrator and Medical Director on payroll.
State hospice license application · ACHC accreditation application · Policy & procedure manual development · QAPI program framework · Emergency preparedness plan · Administrator & Medical Director on payroll · Compliance binder buildout · Clinical documentation standards
Cost: $90KADC: 0Revenue: $0
Phase 4: Team hiring & readiness
Months 4-6. Marketer, equipment, MatrixCare training. Full team assembled.
Cost: $96KADC: 0Revenue: $0
Phase 5: Operations begin, no Medicare cash
Months 7-9. First patients admitted. Revenue booked but Medicare hasn't paid yet.
Cost: $154KADC: 1 -> 4Cash in: $0
Phase 6: Survey & accreditation
Months 10-12. PTAN survey. Still waiting on Medicare. Peak cash deficit: $541K per office.
Cost: $201KADC: 5 -> 8Cash in: $0
Phase 7: Medicare pays, climb back
Month 13+. Medicare back-pay arrives ($123K lump sum). Regular monthly payments begin. Cash-flow positive by month 16.
ADC: 10 -> 18Monthly cash: +$8.6K
ADC ramp per office is conservative
The model assumes 1.4 net new patients per month from first patient admitted. Idaho Falls has achieved a 2.1 growth rate as our first office with no prior knowledge and no home office team. Later offices with a repeatable system and dedicated home office support should ramp faster.
ADC growth curve per office
Modeled ADC per office
Home office leadership team.
The home office infrastructure required before opening a single new office. Click any role to explore.
Founder
Joshua Owen
Executive
Branch Level - Per Market
Medical Director
Reports to Administrator
Physician oversight, plan of care certification, clinical governance
Branch Administrator
Reports to Dir of Ops
Owns the branch: hiring, P&L, growth, people
Hospice Marketer
Reports to Dir of Growth
Census growth, admissions, community education
Clinical Staff (PRN)
Reports to Administrator
RNs, Social Worker, Chaplain, Aides, Volunteers
Click any home office role to see ownership, compensation, and guardrails.
28 target markets.
Verified against CMS, Census ACS, and FY2026 Hospice Wage Index. Each market was selected through a combination of data analysis and prior relationships, professional connections, and on-the-ground knowledge that give us a real entry advantage. Click any market for the full brief.
MidwestSouthWestNortheastHQ
Growth phase simulator.
Launch 2 new office builds per month for 5 months. Each office assumes 18 months from first patient to 25 ADC. Drag the slider to walk through the 24-month expansion.
1
Offices launched
2
Portfolio ADC
0
Monthly cash flow
-$104K
Month 1
Launching the build process for offices 1 and 2.
Cumulative cash flow.
The portfolio bottoms out at -$7.4M around month 21, then climbs back as mature offices fund younger ones.
Peak capital need
$7.4M
Month 21
Cash-flow positive
Month 22
+$52K first month
Total spend to breakeven
$11.6M
Offset by $4.3M inflows
Cumulative cash flowMonthly cash flowMonthly positive
The math on recovery
Total startup and operating costs before monthly breakeven: $11.6M. Cash inflows during that period: $4.3M. Net peak deficit: $7.4M. After month 22, the portfolio is self-funding.
Conservative capital recommendation: $8.5M
The $7.4M model accounts for every known operating cost, but scaling 10 offices across multiple states will surface expenses that are difficult to predict upfront. Capitalizing the portfolio at $8.5M provides adequate cushion for the full build.
Portfolio census build.
Each color represents one office. Older offices carry the portfolio while newer ones ramp.
Office 1Office 2Office 3Office 4Office 5Office 6Office 7Office 8Office 9Office 10
Month 12 ADC
52
All 10 offices seeing patients
Month 18 ADC
144
Avg 14.4 per office
Month 24 ADC
228
Avg 22.8 per office
Why this is conservative
Every office in this model grows at the same flat rate. In reality, offices 5-10 benefit from brand awareness and operator experience. If later offices ramp even 30% faster, the capital need drops significantly.