Margin CompressionDeclining net and EBITDA margins reduce the cash available to fund organic growth, acquisitions, and shareholder returns. Sustained margin pressure erodes return on invested capital, makes the roll-up strategy less accretive, and increases vulnerability to wage or reimbursement shocks over time.
Choppy Multi-year EarningsHistoric losses followed by recovery signal inconsistent profitability, complicating long-term planning, integration of acquisitions, and forecasting. Persistent earnings volatility can raise funding costs, hinder sustained margin improvement, and undermine confidence in the sustainability of growth initiatives.
Low Cash Conversion Vs SalesOperating cash flow that covers only ~40% of sales indicates limited cash conversion efficiency and a narrow buffer against working capital swings or reimbursement delays. This constrains internal funding for expansion and raises reliance on external financing for larger acquisitions or capex needs.