Business Advising Case Study - Managing Profit & Cash Flow




A historically successful medical practice was suffering from declining profits and cash flow. Turnover within the accounting department was high, and reporting was inconsistent and often unreliable. The owners felt that too much of their time was spent putting out fires instead of building the practice. Two of the owners were close to retirement and wanted to sell their interest in the company to the other partners.


The owners wanted to overcome the following issues:

  • Too much time was being spent managing the accounting staff.
  • Cash requirements were often a surprise to the owners.
  • Financial reports were late and unreliable.
  • Profitability and cash flow were below the owners’ expectations.
  • Conflicts had arisen between owners regarding the direction of the business.
  • The practice value was less than what the owners required for retirement.


  • Management needed to maintain control over bill payments and access to financial reports.
  • A reporting solution had to be available from anywhere, on any technology platform, and at any time.
  • Timeliness and technical accuracy were vital and at the core of all financial discussions.
  • Management wanted visual dashboards that showed, at a glance, comparisons to key performance indicators (KPIs) and benchmarks.
  • Professional and impartial feedback was important for ongoing communication.
  • All voices needed to be heard before making important business decisions.
  • Recommendations for improvement opportunities were requested and welcomed.


  • The client transitioned to a managed accounting model with our team. Billing and collections processes remained in-house. We became responsible for bill processing, payments, payroll, regulatory reporting, general ledger maintenance, and financial reporting.
  • The practice’s books were set up on QuickBooks Online to give management access to all financial information from anywhere, on any device, at any time.
  • The owners chose for bill processing and payments, allowing management 24/7 access and the ability to view all bills, approve payments, and authorize the timing of payments.
  • Weekly cash reports were provided to the owners for transparency and planning.
  • We began providing all payroll services, including disbursements, bonuses, quarterly reporting, payment of required withholdings and taxes, and setup of new hires.
  • Dashboards were created using Fathom Reports. The dashboards were tailored to management’s needs after determining appropriate industry comparisons, KPIs, and targets.
  • Cash projections, break-even analyses, and budgets were built and used as planning and measurement tools.
  • Regular meetings were established to discuss results and concerns with the owners. Meetings included a facilitated review of financial results, identification of concerns and opportunities, strategic planning, goal setting, and general questions.


  • Perform an assessment to identify the company’s and owners’ needs.
  • Review current financial data and analyze initial items that should be addressed.
  • Establish agreed-upon procedures and schedule for managed accounting services, including an expected month-end close date.
  • Convert to recommended software solutions and provide training as needed.
  • Provide monthly financial statements with discussions centered on key items driving the numbers and suggestions for growth opportunities.
  • Identify key performance indicators (KPIs), and track progress against goals and the industry.
  • Analyze trends and seasonality to establish monthly budgets and anticipated cash flow.
  • Provide continuous communication by meeting regularly as well as attending internal meetings with the client’s management team.

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Modesto, CA 95350

(209) 527-4220 (phone)
(209) 527-4247 (fax)


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