Fractional CFO FAQ for medical practices

A fractional CFO is a senior finance executive who runs your financial strategy part-time, for a fraction of a full-time salary. You get the same judgment a full-time CFO brings, sized to what your practice actually needs, without carrying the whole seat. The role sits above your bookkeeper and CPA and owns the forward-looking work neither of them is staffed to do.

It runs the financial strategy a full-time CFO would, part-time. That means a P&L rebuilt by provider, location, and service line, payer mix and denial economics read as margin rather than paperwork, a 13-week cash forecast, the few KPIs that actually drive profit, and reporting your partners and lenders can trust. It is the forward-looking layer your bookkeeper is not built to own.

The Margin Map is a fixed-scope, $7,500 diagnostic that runs about 3 weeks. You get your P&L rebuilt by provider, location, and line, a 13-week cash forecast, and a ranked list of margin opportunities with a dollar value on every item. It is how most practices start with me, because you see exactly what a CFO is worth in your numbers before committing to anything ongoing.

It is how I run the work, in three phases. First the Margin Map, a fixed-scope diagnostic that finds where your margin is leaking. Then Build, where I stand up your live dashboard, an on-time monthly close, and the numbers that matter. Then an Operating cadence, a weekly KPI flash and a monthly review so you run the practice on current numbers instead of old ones.

When the questions have outgrown the bookkeeper's seat. If cash surprises you, if your P&L arrives weeks late and only tells you what already happened, or if you cannot say which provider or location makes money, you have hit that line. A new provider or second location that still comes down to gut feel is another clear signal.

Usually not yet. Below roughly $5 million in revenue, while the picture stays simple, a good bookkeeper plus a CPA you trust covers most of what you need. Keep your books clean, learn to read your core numbers, and run a 13-week cash forecast, so the fundamentals are solid before complexity arrives.

Owner-operated medical practices roughly between $5 and $50 million in revenue: physician groups, ambulatory surgery centers, and office-based labs among them. Healthcare is my flagship specialty because payer mix, denials, provider comp, and case-level costing are their own world, and I have built practice finance down to profit per case before.

I do this work personally, so retainer capacity is capped at about 5 clients at a time. That is the point, not a limitation. You get a senior CFO who knows your numbers, not a junior handed your account while a name stays on the invoice.

Yes, and that is where clean numbers pay off most. Private equity is rolling up practices in almost every specialty, and those platforms arrive with better math than most owners have on their own side. I recast the P&L the way a diligence team will want it, flag the add-backs, and keep schedules that hold up in a data room, so you negotiate from strength.

Quality of earnings, or QoE, is the diligence exercise a buyer runs to test whether your reported profit is real and repeatable. They normalize your earnings, strip out one-time items, and re-add owner discretionary costs to land on a defensible number. Getting your books into that shape before a buyer does it for you is how you protect your valuation.

Completely. I take no fee, commission, or referral cut from any private equity firm, buyer, or billing company, ever. I am paid by you and only you. Whatever your numbers say, I have no reason to say anything but that, which is exactly what you want in the person reading them.

Their team works for them, not for you. In a sale, the side with cleaner numbers and its own independent read sets the terms. Having a CFO on your side of the table, one with no stake in the deal closing, is how owners keep the buyer's math honest and hold their price.