Independent fractional CFO · Healthcare
You're running a practice doing $5 to $50 million on last month's numbers.
Stop finding out cash is tight when the balance drops. With a financial command center you see the squeeze 13 weeks out and run your practice on this week's numbers, not last month's: profit by provider and location, your real payer mix, a rolling 13-week cash forecast, and a live dashboard you actually check. It starts with the Margin Map, a 3-week diagnostic at $7,500 flat.
- Margin Map
- 3 weeks
- Fixed price
- $7,500
- Cash horizon
- 13 wks
- Retainer capacity
- 5 clients
You green-light a hire or a new piece of equipment because the P&L looked fine. Three weeks later payroll and a quarterly tax payment hit the same week, and cash is suddenly tight. Nothing went wrong in the practice. You just couldn't see it coming.
01 · The Monday problem
If any of this sounds like your Monday morning, keep reading.
- 01Cash surprises you. You find out it's tight when the balance drops, instead of seeing the squeeze 13 weeks out.
- 02Your P&L shows up on the 20th and tells you what happened six weeks ago.
- 03You know total revenue, but you can't say which provider, location, or service line actually makes money.
- 04Your bookkeeper records the past just fine, but nobody has the tools or the time to plan the future.
- 05Big decisions, like a new provider or a second location, still come down to gut feel.
- 06You've priced a full-time CFO. Market rates run from $275,000 to $500,000 all-in depending on company size, and that math doesn't work at yours.
02 · The Command Center Method
The Command Center Method
I ran finance organizations in the Army, where a command center is a real room: live data on the wall and one person accountable for every number on it. Your practice deserves the same thing, sized to fit. The method has three phases. How I work, in one line: I'm an independent fractional CFO, paid only by you. No fee, commission, or referral cut from any private equity firm, buyer, or billing vendor, ever. Whatever the numbers say, I have no reason to say anything but that.
- 013 weeks
The Margin Map
A paid diagnostic with a fixed scope and a fixed price of $7,500. A quick word for whoever runs your books: this assesses the finance function, not the person. Your bookkeeper or controller stays in the room and comes out with better tools, not a list of mistakes. The forward-looking layer is usually just missing, and building it is the point. You get a rebuilt P&L by provider, location, and line, a 13-week cash forecast, and an opportunity list with a dollar value on every item.
- 02About 90 days
Build
I build your command center: a live dashboard, a monthly close that lands on time, and the handful of numbers that actually drive your margin, like gross margin per case and how fast a dollar of work becomes a dollar of cash.
- 03Ongoing
Operating Cadence
A weekly KPI flash and a monthly operating review. You run the practice on current numbers instead of reacting to old ones.
03 · Your world
Where your practice hides its margin
In a practice, margin hides in a handful of specific places: profit per provider, your payer mix, denials and aging AR, and what the January code transition did to your top line. I find where yours is leaking, then rebuild your P&L, your 13-week cash forecast, and your opportunity list around it. It's the same build every time, pointed at your practice's own numbers.
If you're not a medical practice, you're still in the right place. I take a small number of owner-operated companies in this same $5 to $50 million range, and you get the identical build, the identical Margin Map, and the same front door as everyone else, no waiting room. The failure pattern is the same, and your margin just hides somewhere else.
04 · Already running in a real practice
Already running inside a real practice
A multi-provider vascular and interventional practice in the Pacific Northwest couldn't tell you which providers actually made money. I rebuilt their P&L down to cost per case, across 1,986 cases, 5 providers, and 50 months of history, and put it on a live dashboard. This is a practice like yours, and you can read the whole build end to end.
See the full case study- More than 40 engagements with owner-operated companies, spanning CFO seats, operations work, and M&A support.
- Before that, over a decade in U.S. Army finance and executive roles with budgets from $135 million to $12.8 billion. The discipline comes from that world, and the whole point of Koen Advisors is applying it at owner scale.
- CFO of the Walter Reed Army Institute of Research, a research budget over $2 billion across 4 continents.
- MBA and MHA from Baylor. FACHE, CDFM, and Lean Six Sigma Black Belt.
05 · When you sell
Building toward a sale?
Private equity is rolling up practices in almost every specialty, and those platforms show up with better math than most owners have on their own side. Whatever you're building toward, a cleaner operation, a second location, or a sale that pays what the business is worth, I make the numbers ready for it. On five closed sales I sat as the sell-side CFO on the recast P&Ls, WIP schedules, and roll-forwards that survived diligence. I've helped owners sell into private equity and to fellow independent practice owners. I don't promise your outcome. I make sure your numbers are ready for it, so when the moment comes you negotiate from strength instead of scrambling.
A fit
Who this is for
- Physician-owned practices, medical groups, ASCs, and OBLs doing $5 to $50 million a year.
- Practice owners whose bookkeeper is great at recording the past, but who have nobody turning the numbers into forward decisions.
- Owners who want to see their numbers weekly and act on them, rather than filing them away.
- Not a medical practice? You're still in the right place. I take a small number of owner-operated companies in this same $5 to $50 million range, with the identical build and no waiting room.
Not a fit
Who it's not for
- Practices and companies under $5 million. At that stage a solid bookkeeper will serve you better than a CFO.
- Anyone shopping for outsourced bookkeeping. I work alongside your bookkeeper rather than replacing them.
- Owners who want a binder of recommendations and no change to how they operate.
- Practices with a full finance team already in place. At that point you need another hire rather than a fractional CFO.
The honest comparison
The honest comparison
You already have a bookkeeper
You keep your bookkeeper for what they're good at: recording the past. You don't hire a controller to turn that into forward visibility, you don't learn to build the reports yourself, and you don't wait until month-end to know where you stand. That layer is what I build.
You've priced a full-time CFO
A full-time CFO is a $275,000 to $500,000 seat, plus benefits, plus the job of managing them, and a first-time hire has seen exactly one practice: yours. I bring 40-plus engagements and a healthcare-finance background, including CFO of the Walter Reed Army Institute of Research, an MHA, and the FACHE credential. I plug in at the level you actually need, and you keep the senior judgment without the seat.
Interactive
CFO Cost Calculator
A full-time CFO at your size runs $275,000 to $375,000 all-in. The Command Center Retainer runs $90,000 to $150,000. That's $125,000 to $285,000 a year back.
Estimates based on market compensation benchmarks for your revenue size.
Or skip ahead andget your Margin Map.
Start here
Start with the Margin Map
It's one engagement with a fixed scope: 3 weeks, $7,500 flat. You get a rebuilt P&L by provider, location, and line, a 13-week cash forecast, and a prioritized opportunity list with a dollar value on every item. Then you decide if you want help executing it.
If the Margin Map doesn't identify at least 3 times its fee in margin opportunities, you don't pay. And if you continue to a retainer, the full $7,500 is credited to month 1.
I do this work personally, so retainer capacity is capped at 5 clients at a time.
For scale: market rates for a full-time CFO run from $275,000 to $500,000 all-in depending on company size, and a year of fractional CFO work runs $90,000 to $150,000. The Margin Map is $7,500, and it shows you exactly what that kind of help would be worth in your practice.
Three weeks from now, you could know exactly where your margin hides.
Book a short call. We'll talk through your practice and whether the Margin Map fits. If it doesn't, I'll tell you and point you somewhere useful.
Know an owner doing $5 to $50 million who needs this? Send them this page. A referral from a peer beats anything I could ever write here.