MAYWELL_CASHFLOW_MODEL_2026-08-30.xlsx and MAYWELL_MODEL_CHANGELOG_2026-08-31.md govern. Growth story: referral acquisition and conversion, not hiring — the practice is demand-constrained from spring 2027.On your own assumptions, the entire profit of this business for the next twelve months is the arbitration recovery. FY1 revenue is $3,618,880, of which $1,078,758 — 30% — is arbitration. Strip both tracks and operating cash flow falls from $1,105,502 to $26,744. The core practice, with two PAs and a $20K rent base, runs at breakeven. Everything above breakeven is money currently sitting unpaid in a queue.
By FY2 that improves — the core practice throws off $260,748 once David is at plateau and the PA pod has matured — but for the next twelve months, arbitration is the profit.
That is not an argument against the forecast. The assumptions are yours and they are defensible. It is an argument about where the attention goes — and the lane that carries 30% of FY1 revenue is staffed by one contractor at 42 hours a month.
New patient flow is falling. Practice-wide new patients ran 151.4/month trailing-12 and 128.7/month trailing-3 — down 15%. Revenue growth here comes from visits already booked, the PA pod, and arbitration. It does not come from more new patients, because there are not more new patients.
Two of the three growing channels are the ones that pay worst. Jason Brown / CCC books at 33.5%, the worst named converter in the book, and is up from 6.3 to 16.3/month. Morgan & Morgan — the attorney/lien channel — is up from 8.2 to 10.0. Meanwhile the referring-physician network is shrinking on almost every name.
| Lane | Population | Basis | Value |
|---|---|---|---|
| Track B — WC / No-Fault | 4,052 unpaid lines, $5,116,084 charged 98% matched to a listed CPT | 33% of the WC fee schedule 8-month average pay from 1 Sep 2026 → centred May 2027 | $737,978 at schedule $243,533 expected |
| Track A — OON / IDR | 2,800 unpaid lines across 1,967 claims, $3,241,947 charged | 50% of claims collect, drawn at random seed 20260830 → 984 claims, $1,694,313 of charges (52.3%), × 96.8% collection on award | $1,640,095 expected |
| Combined | 6,852 unpaid procedure lines | $1,883,628 |
| Line | FY1 | per month | FY2 | per month | change |
|---|---|---|---|---|---|
| REVENUE | |||||
| Core practice — Mayrsohn panel | $2,326,523 | $193,877 | $2,178,308 | $181,526 | -6% |
| PA pod — Shivani + Jessica | $213,600 | $17,800 | $345,600 | $28,800 | +62% |
| Arbitration — Track A, OON / IDR | $875,814 | $72,984 | $693,289 | $57,774 | -21% |
| Arbitration — Track B, WC / No-Fault | $202,944 | $16,912 | $40,589 | $3,382 | -80% |
| Total revenue | $3,618,880 | $301,573 | $4,066,286 | $338,857 | +12% |
| PEOPLE | |||||
| W-2 payroll incl. employer burden | $1,054,836 | $87,903 | $1,086,481 | $90,540 | +3% |
| Contractors (1099) | $114,562 | $9,547 | $117,999 | $9,833 | +3% |
| Shivani (PA) | $130,000 | $10,833 | $130,000 | $10,833 | +0% |
| Jessica (PA) | $124,000 | $10,333 | $150,000 | $12,500 | +21% |
| David Jevotovsky — base | $0 | $0 | $335,000 | $27,917 | new |
| David Jevotovsky — production bonus | $0 | $0 | $96,460 | $8,038 | new |
| Total people | $1,423,398 | $118,616 | $1,915,940 | $159,662 | +35% |
| OPERATING | |||||
| Rent & occupancy | $224,000 | $18,667 | $240,000 | $20,000 | +7% |
| Clinical services vendors | $220,572 | $18,381 | $227,189 | $18,932 | +3% |
| Medical supplies | $38,082 | $3,174 | $51,321 | $4,277 | +35% |
| IDR / arbitration filing fees | $30,410 | $2,534 | $31,323 | $2,610 | +3% |
| Athena / practice management | $137,517 | $11,460 | $154,519 | $12,877 | +12% |
| Software & admin | $96,449 | $8,037 | $99,343 | $8,279 | +3% |
| Insurance | $52,646 | $4,387 | $54,226 | $4,519 | +3% |
| Legal & professional | $24,328 | $2,027 | $25,058 | $2,088 | +3% |
| Contractors & reimbursements | $71,160 | $5,930 | $73,295 | $6,108 | +3% |
| Business spend on the cards | $151,954 | $12,663 | $156,513 | $13,043 | +3% |
| Credit-card interest | $2,433 | $203 | $2,506 | $209 | +3% |
| U.S. Bank financing | $40,428 | $3,369 | $40,428 | $3,369 | +0% |
| Total operating | $1,089,981 | $90,832 | $1,155,720 | $96,310 | +6% |
| OPERATING CASH FLOW, before owner comp | $1,105,502 | $92,125 | $994,626 | $82,886 | -10% |
| Operating margin | 30.5% | 24.5% | |||
| Kept visits | 12,694 | 1,058 | 17,107 | 1,426 | +35% |
| Revenue per visit | $285 | $238 |
| Channel | Lifetime | Aug 25 | Sep | Oct | Nov | Dec | Jan 26 | Feb | Mar | Apr | May | Jun | Jul | T3/mo | T12/mo | Trend | Booking | Visits/pt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Zocdoc | 782 | 20 | 23 | 24 | 16 | 14 | 22 | 9 | 19 | 32 | 9 | 35 | 38 | 27.3 | 21.8 | UP | 57.9% | 5.5 |
| Quantum PT | 273 | 23 | 19 | 30 | 7 | 15 | 12 | 35 | 18 | 17 | 21 | 12 | 7 | 13.3 | 18.0 | DOWN | 71.8% | 4.4 |
| Jason Brown / CCC | 164 | 1 | 2 | 3 | 3 | 0 | 5 | 3 | 6 | 4 | 13 | 19 | 17 | 16.3 | 6.3 | UP | 33.5% | 6.9 |
| Morgan & Morgan | 102 | 1 | 2 | 8 | 11 | 11 | 8 | 9 | 11 | 8 | 9 | 15 | 6 | 10.0 | 8.2 | UP | 60.8% | 4.0 |
| Word of Mouth | 145 | 10 | 6 | 5 | 8 | 8 | 3 | 9 | 7 | 4 | 5 | 2 | 6 | 4.3 | 6.1 | DOWN | 57.2% | 5.1 |
| Google / Web | 119 | 7 | 5 | 5 | 7 | 6 | 5 | 3 | 9 | 9 | 2 | 5 | 5 | 4.0 | 5.7 | DOWN | 53.8% | 4.8 |
| Dr. Jason Tam | 49 | 2 | 4 | 5 | 2 | 6 | 5 | 2 | 1 | 2 | 3 | 6 | 8 | 5.7 | 3.8 | UP | — | — |
| Dr. Mayrsohn / self-ref | 135 | 6 | 12 | 10 | 4 | 4 | 2 | 0 | 2 | 4 | 5 | 5 | 0 | 3.3 | 4.5 | DOWN | 77.0% | 5.0 |
| Dr. Rohan Desai | 114 | 8 | 4 | 9 | 4 | 5 | 1 | 7 | 4 | 3 | 2 | 2 | 0 | 1.3 | 4.1 | DOWN | 71.1% | 6.7 |
| Dr. Stephanides | 78 | 5 | 8 | 7 | 6 | 3 | 2 | 4 | 6 | 5 | 0 | 1 | 2 | 1.0 | 4.1 | DOWN | 57.7% | 6.5 |
| ALL SOURCES | 175 | 170 | 221 | 136 | 174 | 134 | 127 | 144 | 150 | 107 | 142 | 137 | 128.7 | 151.4 | DOWN | 61.3% | 5.7 |
Zocdoc is the engine. 782 lifetime patients, trailing-3 at 27.3/month against a trailing-12 of 21.8, and 35 then 38 in the last two months. It books at 57.9% and delivers 5.5 visits per kept patient. It is the only large channel that is clearly accelerating on its own.
Quantum PT is falling, and the Jevotovsky case rests on it. The ramp case assumes 21 patients/month from Quantum for David alone — a quarter of his target panel. The trailing-12 is 18.0 and the trailing-3 is 13.3, with the last two months at 12 and 7. That is not a rounding difference; it is the largest single input to the deal moving the wrong way while the deal is being negotiated.
The physician network is decaying. Desai (relocating, known), Stephanides, Alcarez, Shah, self-referral — all down. The corpus already named the mechanism: reciprocity. Organisations Maywell refers to send back 37.5 patients on average; those it does not send to average 12.8. Maywell has sent 132 patients out in its entire history, about 4/month. Outbound referral volume is the leading indicator, and inbound lags it by four months.
Growth is concentrating in the channels that pay worst. Jason Brown / CCC is up from 6.3 to 16.3/month and books at 33.5%, the worst named converter in the book. Morgan & Morgan is up from 8.2 to 10.0 — the attorney/lien channel, where the Athena data shows Self-Pay/NF/lien collecting at 7.8% of charges against 8.7% practice-wide, and taking a 42-day median to pay against 16 days for Medicare.
| Month | Referred | Booked | Never booked | Booking rate |
|---|---|---|---|---|
| June 2026 | 166 | 89 | 77 | 53.6% |
| July 2026 | 149 | 72 | 77 | 60.3% |
| Corpus baseline, 2026-08-16 | 61.3% |
| Age since registration | Patients | Share | Of which *SELF PAY* |
|---|---|---|---|
| 0–90 days | 206 | 13.4% | 63% |
| 91–180 days | 180 | 11.7% | 58% |
| 181–365 days | 427 | 27.8% | 56% |
| 1–2 years | 538 | 35.0% | 48% |
| 2 years+ | 186 | 12.1% | 45% |
| Total referred and never booked | 1,537 | 53% |
| Measure | Value | Read |
|---|---|---|
| Touchpoints logged | 344 | Text 123 · in-person 78 · email 55 · phone 36 · dinner 6 |
| To organisations that have referred | 116 | Reciprocity maintenance |
| To organisations that never have | 74 | Prospecting |
| Targeted contacts on the list | 311 | |
| Referrals those contacts produced, May + June | 41 | |
| Contacts producing zero | 281 | 90% |
| Referral channel for David | Ramp case assumes | Actual, trailing 3 | Gap | Basis |
|---|---|---|---|---|
| Quantum / Birnhak | 21 /mo | 13.3 /mo | −7.7 | VERIFIED — falling |
| Zocdoc share | 15 /mo | 27.3 /mo total | headroom | VERIFIED — rising |
| Other existing referrals | 12 /mo | network shrinking | — | VERIFIED |
| Paid search @ $2k/mo | 6 /mo | not yet running | — | MODELED, $250–400 CAC |
| Subtotal vs the 80/mo he needs | 54 /mo | gap 26/mo | ≈9 new sources at 3/mo |
AlFarra is the only second-interventionalist data that exists. Rendering-provider data, Jul 2025 → Jan 2026: 1,036 lines, 655 claims, $1,228,211 charged, $86,614 collected — a 7.1% yield, $132 per claim. Against a ramp case that plans David at $220/visit.
His book was 69% *SELF PAY* by charges — $845,356 charged, $60,695 collected. That is the No-Fault and lien population, exactly what the ramp case means when it calls David's panel "Quantum-heavy, 71% NF/WC."
And the compensation structure is the real lesson. Per the corpus, AlFarra started on 50% of collections; that failed precisely because his patients were liens and no-fault requiring arbitration that Maywell had no implementation for. So the deal was changed to 95% of expected collections, paid out on a fee schedule. Valuing his lines at the NY WC schedule gives $153,193; at 95% that is roughly $145,533 paid against $86,614 collected — about 1.7× . The January 25, 2026 written agreement then became the subject of a four-month payment dispute.
So the David term sheet has to pay on cash, not on expected. The ramp case already flags that §2 pays only on services personally performed — that fixes attribution. It does not fix the basis. Paying a percentage of expected collections on a panel that is 71% NF/WC is precisely how the practice paid AlFarra 1.7× what it collected on him.
The gap is closable, and arbitration is what closes it. AlFarra has $521,080 of unpaid procedure charges. At the corpus's NF arbitration rate of 8.5% that recovers $44,292 and lifts him to $200/claim; at 10.2% he reaches $213. The $220 plan rate is reachable — but only through the arbitration lane, worked properly.
1 · Arbitration has to actually run. It is 21% of FY1 revenue and it is staffed by one contractor at 334 hours year-to-date — about 42 hours a month. $163,500 of awards are won and unpaid, four are past their payment window and one is 251 days old. This is the highest value-per-hour work in the business and it is the thinnest resourced.
2 · The PA pod has to produce. Modelled at $120 per visit, sourced from Timoney's 351 mature claims — 54% of Mayrsohn's $224. Shivani and Jessica still have zero billing lines, so nothing about them is measurable yet. Fixing rendering-provider attribution is the precondition for everything else on this page.
3 · Quantum has to be redirected, or replaced. 13.3/month and falling against 21 assumed. Nine new sources at 3/month each is the stated plan; new relationships reach 5+/month in a median of four months, so autumn seeding produces before September 2027 — but only if the seeding starts.
4 · Outbound referrals have to reach 20+/month. Currently ~4. This is the leading indicator for everything in the growth table, and inbound lags it by four months.
5 · New patient flow has to stop falling. 128.7/month against 151.4 trailing-12. Nothing in this forecast assumes it recovers — but nothing in it survives a further decline either.