Medical & Specialty Practices
Collections that reconcile to production. Provider compensation tracked with structure. Advisory for equipment decisions, new providers, buy-ins, and growth.
Practice Economics
A practice produces care and generates charges. What actually arrives in the bank is something different. Patient payments come through one channel. Insurance remittances come through another, often in batches with adjustments and contractual write-offs already applied. The gap between what the practice produced and what it collected is where profitability lives or gets lost.
This is not a clinical problem. It is a financial one. Someone needs to reconcile collections to production records so the practice knows where it stands. Someone needs to track provider compensation and watch overhead ratios. Someone needs to make profitability visible. That is the work we do, so the people providing care can focus on providing care.
Who This Covers
Who This Covers
Medical practices, dental practices, specialty clinics, optometry, veterinary practices, physical therapy, and group practices with multiple providers. Established practices that have moved past startup mode and need financial structure that matches their clinical operation.
What We Don't Do
What We Don't Do
We do not do medical billing or coding. The billing process feeds the numbers we work with, but our focus is the accounting and financial picture that comes after. We work alongside your billing team or billing service, not in place of them.
The Financial Foundation
The core work is keeping the books accurate and meaningful. That means reconciling collections to production so the practice knows its true revenue. Patient payments, insurance remittances, adjustments, and refunds all need to tie back to what the practice produced. Without this discipline, the financial statements tell an incomplete story.
Beyond the reconciliation, we track provider compensation with the structure it deserves. We watch overhead ratios so nothing drifts unnoticed. Where practices want it, we build visibility into profitability by provider or by service line. This is not vanity reporting. It is the information that drives pricing, staffing, and growth decisions.
Provider Compensation
Provider Compensation
Compensation structures vary widely. Some practices pay guaranteed salaries. Others use production-based formulas. Many blend both approaches with bonuses tied to collections or other metrics. We track compensation against the framework each practice uses and make sure the numbers are clear to everyone involved.
Overhead and Profitability
Overhead and Profitability
Staff costs, facility expenses, supplies, equipment, and insurance all add up. We track the components and watch the ratios so the practice can see where money goes and what overhead looks like as a percentage of collections. Where it makes sense, we break down profitability by provider or service line so owners can see which parts of the operation generate margin.
Where Practices Struggle
The most common problem is a gap between what the practice thinks it collected and what the bank account shows. Insurance remittances arrive with adjustments already baked in. Patient payments trickle through the front desk, the patient portal, and payment plans. Practice management software shows one number, the deposit slip shows another, and the accounting system shows a third. Without disciplined reconciliation, decisions get made on fuzzy information.
Provider compensation is another friction point. When pay is tied to production or collections but the underlying tracking is not solid, trust erodes. Associates question the numbers. Partners spend time explaining instead of leading. What should be a straightforward calculation becomes a recurring source of tension.
Collections That Don't Reconcile
Collections That Don't Reconcile
The billing system says one thing. The bank says another. End-of-month reports from practice management software show a third number. Many practices let this slide because the reconciliation is tedious. Over time, the gap compounds and the financials stop reflecting reality.
Overhead That Creeps
Overhead That Creeps
Staff gets added to handle volume. Equipment maintenance costs go up. Rent increases at renewal. Supplies cost more than they used to. Without regular attention, overhead ratios drift upward and margin shrinks before anyone notices the trend. By the time it becomes obvious, the problem has compounded.
Decisions With Clarity
Clean books are the foundation, but the real value is what they enable. When the numbers are solid, the practice can evaluate opportunities with confidence. Equipment purchases become real financial decisions with financing analysis behind them. Adding a new provider or associate becomes a question with an answer, not a leap of faith. Multi-location growth can be planned rather than guessed at.
Longer-term decisions benefit too. Structuring a buy-in for a new partner. Planning succession for an owner approaching retirement. These decisions shape the future of the practice and the wealth of the owners involved. They deserve financial clarity, and that clarity starts with books you can trust. If your practice needs that foundation and a financial partner who understands practice economics, we should talk. Schedule a consultation and let’s see if there is a fit.
Equipment and Financing
Equipment and Financing
Should the practice buy or lease that new imaging equipment? What does the financing actually cost over time? How does it affect cash flow? We help practices evaluate equipment decisions with real numbers in front of them, not just the monthly payment the vendor quoted.
Growth and Succession
Growth and Succession
Adding a provider, structuring a buy-in, opening a second location, planning an exit. These decisions carry financial weight and long-term consequences. Like law firm owners evaluating partner admissions, practice owners deserve the analysis and structure that leads to confident decisions.
Hawaii's Trusted Accounting and Advisory Partner
The Next Step:
A Conversation
Schedule a call to talk through your business and see if we can help. A real conversation about where you are and where you're headed.
Not Sure Where
to Start?
Request our complimentary Financial Clarity Assessment and we will walk through your results together — no cost, no obligation.