The financial seat most practices never fill.
A fractional CFO for physician-owned practices and ambulatory surgery centers. Monthly numbers you can actually act on, the growth and facility decisions modeled before you commit capital, and a read on what the practice is worth that gets refreshed every year instead of the first time someone makes an offer. Flat fee, scoped in writing before each phase starts.
What owners actually call about.
Almost never "I need a CFO." It is one of these four, and the number underneath it is the part nobody owns.
"I need to price space or services for another physician."
A defensible, bottoms-up number for what it actually costs you to provide it, built so your counsel can work with it, instead of a revenue share that will not survive review.
"My numbers do not agree across systems."
Collections reconciled across the billing system, the books, the returns, and the bank, so there is one earnings baseline everyone can stand behind.
"I want to add a location or a facility."
The expansion, de novo, or facility conversion modeled to a go or no-go before you sign a lease or move any capital.
"Someone made an offer and I do not know if it is fair."
An independent read on the number, what is driving it, and which levers would move it, before you respond.
The standing finance seat, without the full-time hire.
Scoped up or down to the practice. Most owners start with the diagnostic and the cash plan, then keep the seat for the decisions that come after.
Monthly and quarterly performance reviews
A standing review of what the practice earned, what it kept, and what changed, with baselines and goals set once and tracked against every month.
A rolling 13-week cash plan
The standard opening deliverable in a fractional finance engagement (NSKT, Bennett Financials), updated weekly so payroll, distributions, and debt service are visible before they are urgent.
Profitability by location, payer, and service line
Where the money is actually made and where it leaks. Most owners know which patients they like treating and not which mix pays for the practice.
Pricing and cost structure
What it actually costs to provide space, staff, block time, and services, priced bottoms-up so it holds up when an attorney, a partner, or a payer reads it.
Indicative valuation, refreshed annually
A normalized value range for internal management planning, benchmarked against comparable transactions and re-run each year against actuals.
Expansion and facility decisions
De novo sites, second locations, real estate, and surgical facility conversions modeled to a go or no-go before capital moves.
Three seats at the table, each covering what the others do not.
| Comparison criteria | Your attorney | Your CPA | Healthcare M&AI |
|---|---|---|---|
| What they own | Drafts and negotiates the agreement | Files the returns and closes the books | Builds the model and the number |
| The view | Protects the terms and the structure | Knows the historical picture | Reads the numbers forward, to a decision |
| Where the numbers come from | Works from numbers someone else sets | Valuation is a separate discipline | Finds what a buyer would find, first |
| When you call | Once a decision is made | Monthly close and tax season | Before the decision, and every month after |
Three things a bookkeeper cannot give you.
Someone who has sat on the buying side
130+ centers acquired and integrated, $1B+ in transaction volume, and 150+ healthcare services businesses valued. When a transaction comes, you are not starting from zero.
Analysis that is not paid to reach a conclusion
The fee is set before the work starts. The expansion can come back no, the valuation can come back lower than you hoped, and the fee is the same either way.
Built for an owner, not for a fund
The output is a decision you can act on and hand to your attorney and your accountant. Plain language, assumptions shown, models built so they can be re-run when the facts change.
Healthcare M&AI is led by Shawn Rothlis, a practitioner with 8+ years in corporate development, M&A, and strategic finance, including corporate development at a NASDAQ-listed oncology platform and a PE-backed urgent care platform. He previously built and reviewed medical-practice and ASC valuations at HealthCare Appraisers.
That is the reason the read is different. Most of a career spent on the buy side of healthcare M&A means building the target lists, scoring the practices, and sitting across from founder-owner physicians. You get that same lens pointed at your practice, on your side of the table.
You know the scope and the number before each phase starts.
Phase one: diagnostic and quick wins
Where the practice actually stands, what is leaking, and what is worth fixing first. Ends in a findings memo and a scoped plan.
Phase two: valuation and the decision guide
What the practice is worth, what is driving that number, and which levers would move it. Ends in an indicative valuation and a decision guide.
Phase three: the standing resource
Someone to call, regular performance reviews, and an annual refresh that re-runs the models against actuals.
Most owners start at phase one, then stay on as a standing resource whether or not a transaction ever happens. Each phase is scoped and priced in writing before it begins, and you can stop after any one of them. Neither of us is obligated to continue.
Fees. Physician-owner engagements are flat, fixed advisory fees, scoped to the practice and the phase rather than pulled from a rate card. There is no percentage of a raise, no per-physician placement fee, and no fee contingent on a deal closing.
What this is and is not. Every analysis is framed as the numbers and your decision, prepared for internal management planning. It is not a formal valuation opinion, and it is not investment, legal, or tax advice. Where a formal opinion is required, the engagement shifts to independent appraisal coordination: selecting and briefing the outside firm, assembling what it needs, and pressure-testing what comes back, rather than performing that work here.
Founder-owned practices, with something real to decide.
Single-owner practices
One physician carrying the clinical load and the business, with no one watching the number between tax filings.
Multi-provider groups
Several locations or providers, where profitability by site, payer, and service line has never been separated out.
Surgical suite and ASC owners
An office-based surgical suite or a licensed center weighing conversion, syndication, block time pricing, or an outside partner.
Owners with an offer in hand
A letter from a platform or a partner buy-in on the table, and no independent read on whether the number is fair.
Match the scope to the question.
Fractional CFO (this page)
The standing seat: monthly numbers, the decisions in front of you, and an annual read on value.
ASC conversion economics
One question, modeled deep: does converting the surgical suite pencil, and under what assumptions.
Practice valuation
An indicative value range for internal planning, with the drivers ranked and refreshed each year.
Fielding an offer, or wondering what a buyer would pay? The buyer-lens read covers that question on its own. And when the problem is cash rather than strategy, the work starts with stabilization: a 13-week cash plan and the creditor conversations, before anything else.
Buying practices rather than running one? The deal-team engagements cover sourcing, screening, and corporate development for platforms, funds, and banks.
Common questions from practice owners.
How are fractional CFO engagements priced?
Every engagement is scoped and priced in writing before it starts, as a flat fee for the phase in front of you. The number depends on the practice: locations, providers, the state of the books, and what question is actually on the table. You know it before any work begins, and it never moves mid-phase.
What happens in the first 90 days?
A diagnostic of where the practice actually stands, a rolling 13-week cash plan, and one earnings baseline reconciled across the billing system, the books, the tax returns, and the bank. You end with a findings memo and a ranked list of what is worth fixing first.
Do you take a fee if I sell the practice?
No. Physician-owner work is flat-fee advisory only, set before the work starts. The expansion can come back no and the valuation can come back lower than you hoped, and the fee is the same either way. Healthcare M&AI does not facilitate, broker, or intermediate securities transactions.
How is this different from my accountant or bookkeeper?
Your accountant closes the books and files the returns, which is the historical picture. This seat reads those numbers forward: which locations, payers, and service lines actually make money, what the practice is worth today, and which decisions change that.
Do I need a full-time CFO?
Most founder-owned practices do not have the volume of decisions to justify one. The work that matters is monthly and quarterly, plus the modeling around a handful of big calls a year. That is what a fractional seat is sized for.
Do you work with ambulatory surgery centers?
Yes. Surgery centers and office-based surgical suites are a core focus, including conversion economics, facility cost structure, case-mix profitability, and ownership structure modeling. Deeper detail is on the ASC conversion economics page.
Know what the practice is worth, and what would make it worth more.
I will tell you what a buyer would see if they looked at your practice today. No pitch. Just a straight read on where you stand.