The monthly review.
Once a month you sit with someone who has your numbers in front of them: what moved, what caused it, and what it means for the capital decision you are weighing. Owner earnings, contribution by provider and service line, and a rolling forecast you can commit against.
Most owners have never had anyone do this. Within two or three months the effect is that you start reading the statements yourself, and that's the point. We're trying to make you literate in your own practice, not dependent on us.
What the advisory covers
- Monthly financial reviewThe read, a scheduled call walking the closed statements line by line, with the decisions they imply.
- Profitability analysisMargin by provider, service line, and location. Which work funds the practice and which is carried.
- Cash forecastingA rolling forward view so payroll, tax, and equipment payments never arrive as a surprise.
- Capital and expansion modelingWhat a hire, an equipment purchase, or a second location does to earnings and cash before the commitment is made.
- Owner earningsWhat the practice actually pays you once salary, distributions, and add-backs are counted honestly.
- Exit & transition readinessClean books and a defensible earnings number, built over years rather than assembled in a panic.
You're probably ready if…
- You're making six-figure decisions on instinct.Adding a provider, signing a lease, financing equipment, and you're not modeling it first.
- Revenue is up and cash doesn't feel like it.Almost always a collections, deferred revenue, or overhead problem hiding in plain sight.
- You're within a few years of selling or transitioning.The earnings number you'll be valued on is being built right now, whether you're managing it or not.
The questions the monthly conversation answers
Practice owners rarely ask accounting questions. They ask business questions that happen to be answerable only from accounting, and the gap between the two is where most reporting fails.
- Is this month good?Not against a benchmark from a magazine, against your own trailing twelve months, adjusted for the things that make a month unusual.
- Can I afford the associate?What the hire costs fully loaded, what production they need to generate to cover it, and how long the practice funds the gap before they do.
- Why is cash tighter than revenue suggests?The bridge from profit to bank balance: collection lag, principal repayment that never appears on the P&L, and prepaid care already spent.
- Which part of the practice funds the rest?Contribution by provider and service line, so a decision about hygiene, optical or a service mix is made on margin rather than on volume.
- What is this worth, and to whom?Normalized owner earnings kept current, so the answer exists before an acquirer asks rather than being assembled in a fortnight.
Where the engagement sits
The interpretation is the service. Software produces the numbers; this is the hour where someone tells you what they mean and what to do about them.
Tax filing stays with your CPA, who works from closed, accurate financials.
On a transaction, we build the earnings picture a buyer will diligence and tell you what the practice looks like from their side of the table. Brokerage stays with your broker.
Why this does not work on unreliable books
Interpretation is only as good as the file underneath it. A conversation about provider margin is worthless if provider compensation sits inside a single payroll line, and a conversation about cash is worthless if membership revenue was booked on receipt.
That is why the close and the read are one engagement rather than two. The advisory work does not begin until the numbers can carry it.
Frequently asked
What does a CFO do that a bookkeeper doesn't?
A bookkeeper makes sure the numbers are accurate and on time. A CFO interprets them into decisions, forecasting, pricing, hiring, capital purchases, and growth planning. Most practices need bookkeeping-level accuracy beneath any CFO-level strategy, which is why we do both.
How often do we actually meet?
Monthly at minimum, on a scheduled call after the close. Practices going through something specific, an expansion, an associate buy-in, a sale process, usually move to twice monthly for that stretch.
When is a practice ready for CFO advisory?
When you're making decisions bigger than the information you have. Adding a provider, opening a second location, buying equipment on financing, deciding whether to take a DSO or corporate offer. If the decision is six figures and you're guessing, it's time.
Can you help us prepare to sell the practice?
Yes. Clean books and a defensible owner-earnings number are the difference between a valuation you accept and one you negotiate. That work is best started two to three years before a sale, not two months.
How quickly does this start being useful?
The first read usually surfaces something in month one, most commonly a collection gap or an overhead line the owner had never seen isolated. The forecasting and modeling get meaningfully better once we have a few closed months of trustworthy data behind us.
General information for practice owners, not accounting, tax, legal, valuation or investment advice for your situation. MedPraxis CFO is not a CPA firm, a registered investment adviser, or a business broker. Talk to your own CPA, attorney or adviser before acting on anything here.